Cognitive deficits in bipolar disorder are neurodevelopmental rather than neurodegenerative in nature, a recent study has reported. Furthermore, cognitive impairment in bipolar patients appears to be stable, in the majority at least.

HIV positivity, the male sex and the duration of ethambutol treatment are all associated with 1-year improvements in patients with probable or definite nontuberculosis mycobacterial pulmonary disease (NTM-PD), according to a retrospective, multicentre study.

“Early predictive factors for a favourable development of … NTM-PD are important to improve management due to the high mortality of this infection at 5 years,” said researchers.

“The purpose of this study was to search for early factors that could predict at the first year the favourable or unfavourable evolution of NTM-PD,” they added.

Those who improved were significantly younger (p=0.05) and were more likely to be HIV positive (36.9 vs 16.4 percent; p=0.02).

In a multivariate analysis of all patient data, the male sex was found to be significantly associated with improvements in NTM-PD status at 1 year (odds ratio [OR], 2.34; 95 percent CI, 1.26 to 8.16; p=0.02).

Other factors that were significantly correlated with improvements at 1 year were a positive HIV status (OR, 3.23; 1.27 to 8.45; p=0.01) and a longer ethambutol treatment duration (OR, 2.24; 2.11 to 3.41; p=0.001).

Notably, while the male sex was significantly associated with improvements at 1 year, no substantial gender differences in bacteriological culture findings were observed, and males showed a higher mortality at 1 year.

Indeed, previous studies have shown that “[m]en with NTM-PD have been reported as having a worse prognosis in terms of mortality than women,” explained researchers. [Am J Respir Crit Care Med 2010;181:514-521]

Previous studies have reported similar improvements in NTM-PD symptoms in persons infected with HIV. According to researchers, anti-HIV therapies likely contribute largely to this association. [Swiss Med Wkly 2001;131:471-477]

“Restoration of immunity, monitoring of these patients in specialized structures and treatment of NTM-PD have played an important role in improving prognosis,” they said.

In the subset of patients who were negative for HIV, the male sex (OR, 3.54; 1.12 to 14.0; p=0.04) and the duration of ethambutol treatment (OR, 1.90; 1.50 to 3.50; p=0.001) were significantly associated with improvements at 1 year.

Of all the participants, 57.1 percent (n=68) met the ATS/IDSA (American Thoracic Society and the Infectious Disease Society of America) criteria for NTM-PD and were thus identified as those with definite NTM-PD. In this group, the duration of ethambutol treatment was similarly associated with improvements at 1 year (OR, 2.45; 1.82 to 7.45; p=0.01).

“Identifying predictors of improvement at one year of NTM-PD is expected to optimize the management of the disease in its early stages,” researchers concluded.

Cognitive deficits in bipolar disorder are neurodevelopmental rather than neurodegenerative in nature, a recent study has reported. Furthermore, cognitive impairment in bipolar patients appears to be stable, in the majority at least.